A blaze that tore through a Sydney nursing home at dawn, killing three elderly residents, was sparked in two places and police are treating it as "suspicious".

This is a firefighter's worst nightmare. Turning up to a nursing home with elderly people who can't get themselves out of harm's way.

Firefighters were confronted by a horrific scene at the Quakers Hill Nursing Home in north-west Sydney this morning, with three elderly residents dead and dozens left seriously injured by the fire and smoke.

Anguish shows on the face of a resident after being evacuated from the nursing home. Photo: Dallas Kilponen

Fire and Rescue NSW Commissioner Greg Mullins described the scene as "chaotic" and "tragic" as more than 100 fire crews, police and ambulance officers arrived at the nursing home on Hambledon Road, Quakers Hill, just after 5am.

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"This is a firefighter's worst nightmare," Mr Mullins said. "Turning up to a nursing home with elderly people who can't get themselves out of harm's way."

Residents are cared for by emergency crews after being evacuated from the nursing home. Photo: Dallas Kilponen

NSW Police Assistant Commissioner Robert Redfern confirmed three people were found dead, well down on early reports that up to 10 might have died.

The likely cause of death was smoke inhalation, Mr Redfern said.

He said because of the smoke and intensity of the fire there was a risk the death toll would rise.

Nursing home fire

Firefighters have been confronted by a horrific scene after a blaze engulfed a nursing home with thick smoke in north-west Sydney, leaving several elderly residents dead and others seriously injured. Photo: Channel Ten

Mr Smith said there was no sprinkler system in the nursing home, as they were not required by law.

Injured taken to hospital

Out of almost 90 residents, NSW Health said 32 people with smoke inhalation and some with burns were taken to eight hospitals - including the Nepean, Blacktown, Mount Druitt and Westmead hospitals - after the fire.

Police said NSW Health had advised that 14 of those were in intensive care, five with severe burns, at Royal North Shore and Concord hospitals.

Police said 18 were "non-ICU" and are being redistributed across the hospital system to manage capacity.

Most others are residents without serious injuries and are being taken to the Lottie Stewart Aged Care at Dundas and Blacktown Aged Care Nursing Home.

'Suspicious' fire

Police were treating the fire as "suspicious" and the homicide and arson squads had joined fire investigators and forensic officers at the home, Mr Redfern said.

But he stressed that "all fires such as this" were considered suspicious.

Detective Superintendent Michael Willing, from the homicide squad, said homicide detectives were involved because it was a "complex coronial investigation".

"It's going to take a long time to establish what has happened here," Mr Willing said.

"We treat all of these matters as suspicious until we can eliminate the possibility of that being suspicious.

"So at this point, we just don't know what we've got on our hands."

He said it could be days or weeks until examination of the fire scene can be completed, due to fears about the building's stability.

Mr Willing said he was unable to give any details about those who died.

"It's going to take some time to formalise identification processes.

"As you can imagine, it's quite a terrible scene in there and it's going to take time."

Firefighters said when they arrived there were two fires at different parts of the home.

"Flames were coming out of the roof at one end of the building and they immediately called for back-up," Mr Mullins said, adding that black smoke went down to the bottom of the floor.

"The fire has destroyed beds, every bit of furniture ... fire spread through the roof to other rooms."

He said one of the fires started in a bedroom.

Strike Force Westall - led by the State Crime Command's Homicide Squad - has been formed to investigate the cause of the fire.

The NSW State Coroner Mary Jerram examined the nursing home about 10.30am, and had been briefed by police.

Police were unable to say how many staff were on duty when the fire broke out.

Concern for officers

The Reverend Dave Hilliard, the senior state police chaplain, said there was concern for the well-being of two young police officers who were among the first officers to enter the burning building and remove residents.

"They're young and being asked to do some extraordinary things beyond their years," he said. "I'm blown away by them."

Families of victims are still being cared for in the Quakers Hill Anglican Church by counsellors and chaplains from emergency services.

Local families have brought food, drinks and flowers.

One nursing home staff member, who did not wish to be named, said she had spent the morning comforting residents in the church before they were transferred to other facilities.

"They couldn't eat, some of them are diabetic and they were all in shock," she said. "we're all in shock. We don't know what will happen to our jobs either."

Firefighters 'on hands and knees'

Mr Mullins told reporters earlier the fire had been put out but the smoke in the building was very heavy.

"Crews had to literally crawl on their hands and knees into every room in the complex, reach up under the beds, searching cupboards, anywhere where someone may have crawled away," he said.

"So it has taken quite some time because of the thick black smoke to confirm that we had all of the residents cleared."

He added: "You can imagine what it would be like for elderly people in their night clothes, some of them suffering from dementia."

A neighbour who lives over the fence from the nursing home said firefighters jumped into her yard to use her hose to spray down elderly people in beds.

"There were a couple of people in beds ... they were covered in a lot of soot and I would assume they were hosing them as a precaution," said the neighbour, who asked not to be named.

She said it was lucky there was a fire station so close by.

"The fire station hasn't been here all that long. We could have lost a lot more people."

Daughter's rush to elderly mother

Sue Webeck rushed to the home, where her 83-year-old mother, Verna, has lived for 10 years, as soon as she heard the news.

She said she was panicked initially because she didn't know where her mother was.

"We rang everywhere and we couldn't find her," Ms Webeck said. Mrs Webeck was found in a wing near the back door near the car park and her daughter said she was probably one of the first to be evacuated.

She suffered blisters to the face and burns to one of her arms from the heat of the fire.

Church offers refuge

The nearby Quakers Hill Anglican Church is being used as a refuge point.

The Reverend Geoff Bates opened his church doors this morning to 17 residents of the nursing home, their families and the families of those of those lost in the blaze.

"They're confused and disorientated and they want to go home," he said. "They needed to be fed."

Mr Bates said about 40-50 members of his local congregation came to assist and another nursing home from Rooty Hill sent staff to help feed and care for the residents, some of whom have Alzheimer's disease and dementia. he said many were on restricted diets and needed specialist care.

All the residents that were at the church have now been taken away by ambulance to alternative accommodation, but shaken family members remained inside.

New fire station "saved lives"

The mayor of Blacktown City, Alan Pendleton, praised the quick response by firefighters, saying that "probably saved a lot of people".

"The new fire station is just a couple of hundred metres up the road."

Cr Pendleton, who travels past the home every day on his way to work, said the deaths were "devastating".

"I think it's tragic, particularly for all the patients and the people living at the home. Most of them are incapacitated or have dementia and unable to evacuate themselves from the building."

He added that the council would be doing what it could to help the nursing home residents and their families.

The fire is being compared to the Pacific Nursing Home fire in Sylvania Heights on April 29, 1981, in which 16 people died.

The Quakers Hill Nursing Home is owned by the Domain Principal Group.

The nursing home is a 100-bed facility that offers high, low and respite care, the company's website said.

The compound has a large outdoor undercover area and garden and there is a registered nurse on duty at all times, the site said.

Gary Barnier, the general manager of Domain Principal, wouldn't take questions from the media, but thanked staff and emergency services.

Neighbours rush to help

A woman who lives next to the nursing home said she was woken up before 6am by a neighbour and the pair decided to get help.

"I did what I could. I just collected my towels and sheets and whatever I could," said the woman, who asked not to be named.

"It's chaotic ... but everybody seems to be really helping each other out."

The neighbour who lives over the fence said emergency services were at the nursing home very quickly after the fire broke out.

"The next thing there was a plume of black smoke coming up as dawn approached.

"Things got chaotic for a little while. It's a very full-on morning.

"It's a very sad thing to have happened. Luckily we are blessed in our area to have so many hospitals and nursing homes to take other patients in."

Some of Australia's worst fire fatalities in recent years, excluding bushfires

November, 2011: An unconfirmed number of nursing home residents die in a fire at Quakers Hill facility in Sydney’s west.

August, 2011: 11 members of an extended family die in a house fire at Slacks Creek south of Brisbane.

September 1989: Six die in the Downunder Hostel at Kings Cross, Sydney.

August 1981: 19 die at the Rembrandt Hotel in Kings Cross, Sydney.

April 1981: 16 die in the Pacific Nursing Home, Sylvania Heights, NSW

- with AAP and Rachel Browne

She said she was really panicked this morning becauses she didn't know where her mother was.
"We rang everywhere and we couldn't find her," Ms Webeck said,
Verna 83. Lived at home for 10 years.
Was in a wing near the back door near the car park. Was probably one of the first to be evacuated.
Blisters to the face and burns to one of her arms.
Brought many residents to nearby Quakers Hill Anglican church refuge point. Ambulance bus just arrived to take the uninjured away to alternative accommodation.